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See a sample rate comparisonCPT 49595 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Rpr Aa Hrn 1st 10 Rdc, Repair Of Anterior Abdominal Hernia S Ie Epigastric Incisional Ventral Umbilical Spigelian Any Approach Ie Open Laparoscopic Robotic Initial Including Implantation Of Mesh Or Other Prosthesis When Performed Total Length Of Defect S Greater Than 10 Cm Reducible
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49595 |
| Medicaid Fee Schedule | View Medicaid rates for 49595 |
National average reimbursement for CPT 49595 by major payers:
$1,010.08
$1,099.06
$1,057.23
$1,264.47
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CPT 49595
5 of 25 sample ratesHigher to lower in this preview
Austin Gi Surgicenter, LLC, Austin Endoscopy Center
Austin Gi Surgicenter LLC
$4,633.00Published rateSurgery Center Of Mesa LLC
$2,799.00Published rateOpen Access Vascular Access Center, Inc
Open Access Vascular Access Ce
$2,153.00Published rateOrtho Central
$1,400.00Published rateGi Asc LLC
$730.00Published rate
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See a sample payer proposalCPT 49595 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49595 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 49595 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 49591-CPT | Moderate | Rpr Aa Hrn 1st 3 Cm Rdc, Repair Of Anterior Abdominal Hernia S Ie Epigastric Incisional Ventral Umbilical Spigelian Any Approach Ie Open Laparoscopic Robotic Initial Including Implantation Of Mesh Or Other Prosthesis When Performed Total Length Of Defect S Less Than 3 Cm Reducible |
| 49592-CPT | Moderate | Rpr Aa Hrn 1st 3 Ncr Strn, Repair Of Anterior Abdominal Hernia S Ie Epigastric Incisional Ventral Umbilical Spigelian Any Approach Ie Open Laparoscopic Robotic Initial Including Implantation Of Mesh Or Other Prosthesis When Performed Total Length Of Defect S Less Than 3 Cm Incarcerated Or Strangulated |
| 49593-CPT | Moderate | Rpr Aa Hrn 1st 3 10 Rdc, Repair Of Anterior Abdominal Hernia S Ie Epigastric Incisional Ventral Umbilical Spigelian Any Approach Ie Open Laparoscopic Robotic Initial Including Implantation Of Mesh Or Other Prosthesis When Performed Total Length Of Defect S 3 Cm To 10 Cm Reducible |
| 49595-CPT | High | Rpr Aa Hrn 1st 10 Rdc, Repair Of Anterior Abdominal Hernia S Ie Epigastric Incisional Ventral Umbilical Spigelian Any Approach Ie Open Laparoscopic Robotic Initial Including Implantation Of Mesh Or Other Prosthesis When Performed Total Length Of Defect S Greater Than 10 Cm Reducible |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49595. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49595 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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